Mandated Report to Congress: Analysis of Impacts and Issues Relating to Four Medicaid Regulations
September 2009
Prepared for: The United States Congress Under contract to: U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services
Congress directed Secretary of Health and Human Services to describe the problems that four Medicaid regulations were intended to address and their impact, and to commission an independent study on the prevalence of these problems and the potential impacts of four of the regulations:
- Cost Limit for Providers Operated by Units of Government and Provisions to Ensure the Integrity of Federal-State Partnership (CMS-2258-P) – proposed rule published January 18, 2007
- Graduate Medical Education (CMS-2279-P) – proposed rule published May 23, 2007
- Coverage for Rehabilitative Services (CMS-2261-P) – proposed rule published August 13, 2007
- Elimination of Reimbursement Under Medicaid for School Administration Expenditures and Costs Related to Transportation of School-Age Children Between Home and School (CMS-2287-F) – final rule published December 28, 2007, final rule rescinded on June 30, 2009
Overall, we found that states do in fact have difficulty, in some instances, tracking where their Medicaid dollars go and the precise purposes to which these dollars are applied, which, in turn, creates oversight problems with CMS. There is no doubt that many of the issues raised by the Secretary and addressed in the regulations are ones that require continued focus from CMS and the states. On the other hand, we found little evidence within the states to substantiate some of the specific problems expressed by the Secretary in his 2008 report. In addition, many of the more significant concerns identified in the Secretary’s report arise from fundamental disagreements about the appropriate scope of Title XIX. In many cases, while we find that a problem raised by CMS exists in a state, we do not find any indication that the state has acted inappropriately.
The letter approving the report is available by clicking here.